Healthcare Provider Details

I. General information

NPI: 1093974800
Provider Name (Legal Business Name): MAYA MEDICAL CENTERS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 W 95TH ST
EVERGREEN PARK IL
60805-2004
US

IV. Provider business mailing address

8790 W 103RD ST
PALOS HILLS IL
60465-1603
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-1363
  • Fax: 708-422-1256
Mailing address:
  • Phone: 708-200-6615
  • Fax: 708-422-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. HANAN YOUSIF
Title or Position: PRACTICE MANAGER
Credential:
Phone: 708-200-6615